Making health financing work for the poor: An evaluation of equity in health systems financing in Indonesia

让卫生筹资为穷人服务：对印度尼西亚卫生系统筹资公平性的评估

• 批准号: MR/P013996/1
• 负责人: Virginia Wiseman
• 金额: $ 91.95万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FP013996%2F1
• 关键词: Making; health; financing; work; poor

Concerns about the poor and most vulnerable not getting adequate access to quality health care are widespread in low and middle income countries (LMICs) and have led to an intense advocacy for universal health coverage (UHC) in the last 5 years. Effective implementation of UHC requires equity in health care, defined as payment for health services according to capacity to pay and the receipt of benefits according to need. Indonesia has in recent years embarked on a programme to achieve UHC through a national health insurance scheme (Jaminan Kesehatan Nasional - JKN). However, with coverage currently at 65% and the 2019 goal for full coverage fast approaching, a second wave of JKN reforms are being planned to bolster Indonesia's progress.The primary aim of this study is to prospectively evaluate the combined effects of a second phase (2017-2019) of JKN-reforms in Indonesia and provide an overall assessment of progress toward the achievement to UHC. The reforms are designed to address factors currently hindering the effective implementation of the national health insurance scheme and in turn the pursuit of UHC by 2019. Over the next 3 years the government will be initiating and strengthening a number of important reforms ranging from re-structuring provider payment schemes through to socialization campaigns to raise awareness of the scheme and its benefits. Strategies for increasing fiscal space for health through increasing tobacco tax and the phasing out of subsidies on fuel are also proposed. Understanding the equity impact of these reforms and how they may (or may not) be facilitating progress towards UHC is of considerable interest to the government of Indonesia. The study will take a 'whole of system' approach by integrating both the public and the increasingly important private sector of the Indonesian health care system. Using a before and after design, the impact of these UHC reforms will be measured according to three key outcomes: (i) the progressivity of the health care financing system (ii) the pro-poorness of the health care delivery system and (iii) self-reported health outcomes across socioeconomic groups. The quantitative tools of financing and benefit incidence analysis will be used to assess who pays and who benefits from health care spending at baseline (2017) and 2 years into implementation (end 2019). The study will bring together an international research team consisting of those with substantial experience of evaluating UHC-reforms in Africa and the Asia-Pacific and those with an in-depth understanding of the Indonesian health care system. Qualitative studies to document the context pre and post UHC reforms, and the process of implementing UHC reforms will also be undertaken. Stakeholder analysis will be used to support the translation of priority financing reforms identified through the evaluation into viable policy proposals.The study will advance methods in this field by testing different indicators and indexes of 'need', against which the appropriateness of the distribution of benefits from using health services can be assessed. The study will also advance knowledge through a better understanding of the contribution of the private sector to meeting the needs of the poor and in turn, inform through the stakeholder analysis, ongoing discussions about effective engagement with private sector to strengthen progress towards UHC.The over-arching goal of this study is to strengthen the healthcare system of Indonesia through more equitable and sustainable health financing policies. As the fourth most highly populated country in the world, with a total population of around 255 million people, the implications of this study's findings for the design of a universal health system will be far-reaching.

在低收入和中等收入国家，人们普遍担心穷人和最脆弱的人得不到足够的优质医疗保健，并在过去5年中大力倡导全民医疗保险。UHC的有效实施需要卫生保健方面的公平，其定义是根据支付能力支付卫生服务费用，并根据需要获得福利。近年来，印度尼西亚启动了一项方案，通过国家医疗保险计划(Jaminan Kesehatan Nasional-JKN)实现普遍健康保险。然而，随着目前覆盖率达到65%，以及2019年实现全覆盖的目标迅速临近，第二波JKN改革正在计划中，以支持印尼的进步。这项研究的主要目的是前瞻性地评估印尼JKN改革第二阶段(2017-2019年)的综合影响，并对UHC实现这一目标的进展情况进行总体评估。这些改革旨在解决目前阻碍有效实施国家医疗保险计划的因素，进而在2019年之前实现全民健康保险。在接下来的3年里，政府将启动和加强一些重要的改革，从重组供应商支付计划到社会化运动，以提高对该计划及其好处的认识。还提出了通过增加烟草税和逐步取消燃料补贴来增加卫生财政空间的战略。了解这些改革对股权的影响，以及它们如何可能(或可能不)促进UHC的进展，对印度尼西亚政府来说是相当有意义的。这项研究将采取“整个系统”的方法，整合印度尼西亚卫生保健系统中日益重要的公共和私营部门。使用前后设计，这些UHC改革的影响将根据三个关键结果来衡量：(I)医疗保健筹资系统的进步性；(Ii)医疗保健提供系统的亲贫性；(Iii)社会经济群体自我报告的健康结果。将使用筹资和受益情况分析的量化工具，在基线(2017年)和实施两年(2019年底)时评估谁支付和谁受益于医疗保健支出。这项研究将汇集一个国际研究小组，由在评估非洲和亚太地区的UHC改革方面有丰富经验的人和对印度尼西亚医疗保健系统有深入了解的人组成。还将进行定性研究，以记录UHC改革前后的情况，以及实施UHC改革的过程。将使用利益相关者分析来支持将通过评估确定的优先筹资改革转化为可行的政策建议。这项研究将通过测试不同的“需要”指标和指数来推进这一领域的方法，根据这些指标和指数可以评估使用卫生服务的惠益分配的适当性。这项研究还将通过更好地了解私营部门对满足穷人需求的贡献来增进知识，并通过利益攸关方分析，告知正在进行的关于与私营部门有效参与的讨论，以加强在实现卫生保健方面的进展。这项研究的总体目标是通过更公平和可持续的卫生筹资政策加强印度尼西亚的卫生保健系统。作为世界上人口第四多的国家，总人口约为2.55亿人，这项研究的发现对设计全民卫生系统的影响将是深远的。

项目成果

Financing for universal health coverage in small island states: evidence from the Fiji Islands.

• DOI: 10.1136/bmjgh-2016-000200
• 发表时间: 2017
• 期刊: BMJ global health
• 影响因子: 8.1
• 作者: Asante AD;Irava W;Limwattananon S;Hayen A;Martins J;Guinness L;Ataguba JE;Price J;Jan S;Mills A;Wiseman V
• 通讯作者: Wiseman V

The benefits and burden of health financing in Indonesia: analyses of nationally representative cross-sectional data

• DOI: 10.1016/s2214-109x(23)00064-5
• 发表时间: 2023-04-14
• 期刊: LANCET GLOBAL HEALTH
• 影响因子: 34.3
• 作者: Asante，Augustine;Cheng，Qinglu;Wiseman，Virginia
• 通讯作者: Wiseman，Virginia

UICC-ARO Symposium at the UICC 2016 World Cancer Congress How Can We Mobilize Action to Realize UHC in Asia?

UICC-ARO研讨会在UICC 2016世界癌症大会上，我们如何动员行动以实现亚洲的UHC？

• DOI: 10.22034/apjcp.2017.18.11.2897
• 发表时间: 2017-11-26
• 期刊: Asian Pacific journal of cancer prevention : APJCP
• 作者: Akaza H;Kawahara N;Fukuda T;Horie S;Thabrany H;Nozaki S
• 通讯作者: Nozaki S